Periodontology 2000最新文献

{"title":"Association of tooth wear with dentin hypersensitivity: A systematic review","authors":"Giovanna C. Denucci, Knut Adam, Nadine Schlueter, Cecilia P. Turssi, Luciana Butini Oliveira, Sumanth Kumbargere Nagraj, Anderson T. Hara","doi":"10.1111/prd.70090","DOIUrl":"https://doi.org/10.1111/prd.70090","url":null,"abstract":"Objectives The association between tooth wear (TW) and dentin hypersensitivity (DH) is not well understood. This systematic review investigated the role of TW (and etiological factors) as an associated factor for DH. Materials and Methods Literature search was conducted in five databases with terms related to DH and TW, until April 2025. Three pairs of independent reviewers selected clinical studies reporting on DH and TW (and related etiology) in dentate adults, and performed data extraction. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. A structured narrative synthesis was performed. Results Twenty‐one studies were included, with DH prevalence varying from 8.6% to 84.7%. Many indices were used for TW, the most common being BEWE ( <jats:italic>n</jats:italic> = 8); and for DH, the most common being Schiff ( <jats:italic>n</jats:italic> = 7). DH prevalence was higher in patients with (mean: 42.1%) versus without (18.7%) TW. Similar trends were observed when analyzing teeth with (34.6%) versus without (12.4%) TW. DH was associated with specific acidic diets, parafunctional behaviors, and health and lifestyle factors. There was conflicting evidence associating toothbrushing frequency and technique to DH. Conclusions This review provides evidence for a consistent association between DH and TW and some etiological factors, observed across patient‐ and tooth‐level analyses. Clinical Relevance Patients with TW and/or etiological factors—including dietary habits, oral hygiene practices, and parafunctional behaviors—should prompt a thorough evaluation for underlying DH, and vice‐versa. Identifying and addressing these factors will help explain the occurrence of DH and guide effective prevention strategies.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"14 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148858734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dentifrice formulations for the treatment of dentin hypersensitivity: A systematic review and network meta‐analysis","authors":"A. J. Gormley, T. Walsh, J. Twigg, C. Farrugia, A. Pollard, B. Bullock, N. X. West","doi":"10.1111/prd.70088","DOIUrl":"https://doi.org/10.1111/prd.70088","url":null,"abstract":"Objectives To update the evidence on the comparative effectiveness of self‐applied dentifrices for the treatment of dentin hypersensitivity (DH) using systematic review and network meta‐analysis methodology. Materials and Methods Randomized controlled trials evaluating self‐applied dentifrices in adults with a diagnosis of DH were identified through literature searching of OvidSP versions of Medline, EMBASE and the Cochrane Library from November 2022–July 2025, supplemented by records obtained in a previous review and manual citation searching. Outcomes were assessed using validated measures including evaporative cold, tactile and thermal cold stimuli. Random‐effects frequentist network meta‐analyses were conducted for outcomes measured at 2 weeks. Risk of bias was assessed using the RoB 2 and certainty of evidence evaluated using the CINeMA framework. Results Ninety‐three studies (9548 participants) were included, with 47 studies (4636 participants) contributing to the network meta‐analyses. In consolidating findings across different outcome measurements we found stannous fluoride and arginine‐based dentifrices consistently demonstrated the most clinically meaningful reductions in DH symptoms compared with a benchmark fluoride dentifrice across evaporative cold (Stannous Schiff MD −0.85 (95% CI −1.08; −0.62), high confidence rating; Arginine MD −0.78 (95% CI −1.02, −0.54), low confidence rating) and tactile (Stannous Yeaple MD 14.87 (95% CI 10.24, 19.50), moderate confidence rating; Arginine MD 9.78 (95% CI 4.69, 14.86), low confidence rating) outcomes. High‐certainty evidence supported stannous fluoride for evaporative cold outcomes, while arginine demonstrated comparable effect sizes with lower certainty. Other formulations showed small to moderate effects with generally low certainty when compared with a benchmark fluoride dentifrice at 2 weeks. Conclusions Stannous fluoride and arginine dentifrices should be considered first‐line self‐care options for DH. Clinical Relevance Clinicians can recommend the use of stannous fluoride or arginine dentifrices as first‐line treatment for DH, with choice guided by patient preference, tolerability and availability rather than expectation of superior efficacy.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"271 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148858721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Flapless submucosal instrumentation treatment of peri‐implantitis: Contemporary evidence and clinical protocol","authors":"José Nart, Neus Carrió, Gonzalo Blasi, Maria Costanza Soldini, Ramon Pons, Matteo Albertini, Beatriz de Tapia","doi":"10.1111/prd.70091","DOIUrl":"https://doi.org/10.1111/prd.70091","url":null,"abstract":"Background/Aim Peri‐implantitis is a plaque‐associated disease characterized by inflammation of the peri‐implant mucosa and progressive loss of supporting bone, representing a growing clinical and public health challenge. Conventional nonsurgical therapies often provide limited and unpredictable outcomes, while surgical approaches are associated with increased morbidity and variable long‐term success. In this context, minimally invasive strategies, particularly flapless submucosal instrumentation, have emerged as a potential alternative or adjunct in the management of peri‐implantitis. The aim of this narrative review is to critically appraise the contemporary evidence on flapless treatment approaches for peri‐implantitis. Materials and Methods This narrative review analyzes the available literature on flapless submucosal instrumentation for peri‐implantitis, presented as a minimally invasive access approach performed without flap elevation that combines submarginal instrumentation with deliberate peri‐implant degranulation/curettage to improve access to the defect and implant surface, and may be considered in treatable, selected peri‐implantitis cases within a stepwise care pathway. The biological rationale for flapless therapy is discussed based on the histopathological characteristics of peri‐implant lesions, emphasizing the role of inflamed peri‐implant soft tissues as a persistent reservoir of infection. Current mechanical, chemical, and adjunctive modalities employed within flapless protocols are reviewed. Results Clinical, radiographic, systemic, and patient‐reported outcomes associated with flapless treatment approaches are examined. In addition, indications, limitations, and prognostic factors—including defect morphology, implant surface characteristics, prosthetic design, and patient‐related risk factors—are analyzed. Conclusion Although the available evidence remains heterogeneous and is largely derived from nonrandomized studies, flapless submucosal instrumentation appears to be a biologically sound and minimally invasive option for selected peri‐implantitis cases, which may be repeated when clinically indicated while acknowledging heterogeneous protocols and limited comparative evidence. Clinical Relevance Flapless submucosal instrumentation may reduce the need for more extensive surgical interventions. Practical clinical recommendations and step‐by‐step treatment algorithms are proposed to support evidence‐based and patient‐centered decision‐making in the management of peri‐implantitis.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"48 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148858738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guiding the AI revolution in periodontology and implant dentistry: Concepts, ethics, accountability, and a roadmap for sustainable adoption","authors":"Aminollah Khormali, Negin Soghli, Patricia A. Miguez","doi":"10.1111/prd.70078","DOIUrl":"https://doi.org/10.1111/prd.70078","url":null,"abstract":"Background Artificial intelligence (AI) is increasingly gaining attention in the field of periodontology and implant dentistry. Currently developed models can support diagnosis, treatment planning, and maintenance monitoring. However, most of the available literature is based on retrospective and often single‐modality data sets. Therefore, they lack clinical generalizability and underrepresent the multimodal nature of periodontal and peri‐implant diseases. Objectives and Methods This study examines the current status of AI in the field of periodontology and implant dentistry and discusses the associated ethical and translational challenges. A narrative review search was conducted in PubMed, Embase, and Cochrane Library through February 2026. Furthermore, it explains the responsible implementation methods and proposes a roadmap for the sustainable adoption of AI in this field. Results The use of AI showed major promise in the field of periodontology and implantology. The main applications of AI in this field include bone loss detection, detection of intrabony defects, biofilm and microbiome‐related analysis, patient communication, posttreatment monitoring, implant planning, detection of the implant system, and predicting the implant prognosis. Utilizing AI in these domains improved the efficiency, consistency, and access to care to some extent. However, there are major limitations that need to be addressed to move toward a responsible and sustainable use of AI. These limitations include reliance on single modality and single‐center and nonshareable data sets, incomplete integration of clinical and biological variables, limited external validation, and persistent concern regarding bias, privacy, and explainability. These factors frame AI in periodontology as a clinician‐supervised, data‐dependent, and ethically guided technology rather than an isolated diagnostic tool. One of the most important factors that needs to be included in the training of clinicians is that they need to gain education on critiquing the AI outputs, use it as an assistive tool, and never over‐rely on the AI outputs. The current evidence also suggests moving beyond the single‐modality AI toward multimodal systems that better reflect the 2018 periodontal classification and the complexity of periodontal and peri‐implant decision‐making. Conclusion Use of AI has substantially improved periodontology and implant dentistry research. However, a sustainable clinical translation requires responsible implementation of the AI and a stronger data set that represents the multimodal nature of the periodontal and peri‐implant diseases. Moving forward, the data sets being used to train the models need to be multimodal, multicenter, and clinically verified to support the generalizability of the findings. In addition, there needs to be clear ethical safeguards and clinician oversight to make sure the results are interpreted in the correct way. Clinical Relevance As AI is becoming more prevalen","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"136 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148858740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping the omics landscape for peri‐implant diseases: A scoping review","authors":"Ethan Ng, Ioannis Fragkioudakis, Jeniffer Perussolo, John Rong Hao Tay, Elena Calciolari, Nikos Donos","doi":"10.1111/prd.70056","DOIUrl":"https://doi.org/10.1111/prd.70056","url":null,"abstract":"Objectives To map omics evidence across peri‐implant health, peri‐implant mucositis, and peri‐implantitis, and to identify recurring molecular patterns and candidate biomarker signals relevant to diagnosis, monitoring, and treatment. Materials and Methods This scoping review included human studies using genomics, DNA methylation–based epigenomics, bulk and single‐cell transcriptomics, non‐coding RNA analyses (including miRNA, lncRNA, and circRNA), proteomics, metabolomics, and microbiome profiling. Findings were organized by clinical state (health, mucositis, peri‐implantitis) and interpreted within an implant‐conditioned niche shaped by microbial, host, and biomaterial‐related influences. Results Of 319 records identified, 78 studies were included. Most focused on genomics, transcriptomics, and the microbiome, with fewer studies in DNA methylation–based epigenomics, proteomics, and metabolomics. Peri‐implant health was generally associated with oxygen‐tolerant, biosynthetically active microbial communities and a regulated host‐response baseline. Peri‐implant mucositis appeared to be an intermediate plaque‐induced state marked by expansion of bridge anaerobes and early innate inflammatory activation, but it was under‐represented in transcriptomic, proteomic, and epigenomic datasets. Peri‐implantitis was associated with stronger coupling between dysbiosis and host‐destructive responses, including recurrent innate inflammatory hubs, chemokine‐driven myeloid recruitment, protease activity, osteo‐immune imbalance, and catabolic metabolomic profiles enriched in polyamines and short‐chain fatty acids. DNA methylation studies linked disease status, and in limited cohorts, titanium particle burden, with altered methylation patterns. Non‐coding RNA studies suggested additional regulatory networks related to inflammation and bone‐associated signaling. Treatment studies indicated that decontamination may reduce bacterial biomass on rough titanium surfaces, but it does not consistently eliminate residual biofilm, suggesting biological improvements may reflect ecological shifts rather than complete surface decontamination. Conclusions Current omics evidence suggests that peri‐implant disease follows a staged, implant‐conditioned biological trajectory rather than a simple binary healthy/diseased model.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"184 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148858735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Soft tissue grafting for the prevention and management of peri‐implantitis","authors":"Eduardo Montero, Ignacio Sanz‐Sánchez, Myroslav Solonko, Javier Sanz, Javier Calatrava, Mariano Sanz","doi":"10.1111/prd.70084","DOIUrl":"https://doi.org/10.1111/prd.70084","url":null,"abstract":"Aim To critically summarize the current evidence on the role of the peri‐implant soft tissue phenotype [specifically the width of keratinized peri‐implant mucosa (KPIM) and the soft tissue thickness (STT)] and of the soft tissue grafting procedures used for the prevention and management of peri‐implant diseases. Materials and Methods A narrative review of the literature was conducted, using PubMed for articles published up to December 2025, complemented by manual searching of reference lists. All different study designs were considered, prioritizing the highest available level of evidence. Results Peri‐implant diseases are multifactorial biofilm‐induced chronic inflammatory conditions. Their onset, progression, and response to treatment are influenced by the characteristics of the peri‐implant soft tissues, which, unlike periodontal tissues, form a weaker biological seal, rendering them more susceptible to inflammation‐driven tissue breakdown. A reduced width of KPIM is consistently associated with higher plaque accumulation, mucosal inflammation, discomfort during oral hygiene, and a greater prevalence of peri‐implant diseases. It should be emphasized, however, that most of this evidence derives from cross‐sectional and observational studies. KPIM augmentation procedures improve peri‐implant soft tissue health and patient‐reported outcomes, and STT augmentation by increasing mucosal thickness (MT) may enhance soft‐tissue margin stability and reduce marginal bone loss. These benefits are best supported for surrogate outcomes, whereas the independent effect of soft tissue augmentation (STA) on the prevention of peri‐implantitis remains less certain. In the treatment of peri‐implantitis, there is some evidence that simultaneous or staged STA (particularly KPIM reconstruction) may improve clinical stability; however, its effect on disease resolution remains unclear, as most available studies lack a negative control group. Conclusions Soft tissue grafting is a clinically relevant, phenotype‐modifying strategy for preventing and managing peri‐implant diseases. Risk‐based, phenotype‐driven decision‐making (distinguishing KPIM augmentation from targeted STT augmentation) is essential for optimizing treatment outcomes.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"16 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148858737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individualized healing significantly improves pink esthetics around immediate single implants: A systematic review and meta‐analysis","authors":"Xinyi Qian, Boldizsár Vánkos, Gergely Agócs, Kata Kelemen, Alexander Schulze Wenning, Barbara Kispélyi, Gábor Gerber, Gábor Varga, Péter Hermann, Péter Hegyi, Anton Sculean, German O. Gallucci, Krisztina Mikulás","doi":"10.1111/prd.70089","DOIUrl":"https://doi.org/10.1111/prd.70089","url":null,"abstract":"Aim This systematic review and meta‐analysis aimed to compare soft and hard tissue outcomes of applying anatomic healing abutments (AHA) and provisional restorations (PR) versus cylindrical healing abutments (CHA) on immediately placed single implants. Materials and Methods Four databases (PubMed, Embase, Cochrane, and Web of Science) were searched on September 8, 2025, for two‐armed studies comparing AHA/PR to CHA on immediate single‐tooth implants. Outcomes included implant survival (IS), marginal bone loss (MBL), pink esthetic score (PES), patient satisfaction, as well as buccal bone and mucosal changes. Random‐effects meta‐analyses were performed. Results Twenty studies were included; 12 contributed to quantitative synthesis, showing no difference in IS (over 99% in all groups), MBL, or patient satisfaction. Pooled analysis of seven studies (340 implants) showed higher PES with AHA and PR than CHA group at 1 year (MD: 2.54; 95% CI: 1.12–3.96). Descriptive evidence suggested a trend toward improved horizontal tissue preservation with individualized healing. Conclusion Within the limitations of this study, PR significantly improved PES without compromising IS or MBL. Their use may be beneficial, especially in the esthetic region, but further studies are needed to investigate their cost‐effectiveness and long‐term effect, especially on horizontal tissue changes. Clinical Implications Anatomically shaped healing abutments and provisional restorations provide higher pink esthetics around immediately placed single implants, which is especially relevant for restorations in the anterior region.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"159 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148858751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral health and systemic health outcomes: A call for interdisciplinary action.","authors":"Moritz Kebschull, Ryan T Demmer, Nigel Pitts, Huda Yusuf, Gitana Rederiene, Nikolaos Donos, Wim Teughels, Raman Bedi, Orsolya Nemeth, Mia Rakic, Stéphanie Tubert-Jeannin, Raimondo Ascione, Francesco D'Aiuto, James Deschner, Thomas Dietrich, Mili Doshi, Julian Fisher, Ramón Juanatey, Phoebus Madianos, Katalin Nagy, Barry Quinn, Saulė Skinkytė, Lina Stangvaltaite-Mouhat, Maria van den Muijsenbergh, Josep Vilaseca, Nicola West, Anton Sculean, Andreas Stavropoulos, Kenneth Eaton","doi":"10.1111/prd.70086","DOIUrl":"https://doi.org/10.1111/prd.70086","url":null,"abstract":"<p><strong>Objectives: </strong>To make the case, from periodontology and dental public health, for interdisciplinary action on oral and systemic health, and to set out recommendations for practice, policy, education, and research.</p><p><strong>Materials and methods: </strong>A joint working group of the European Federation of Periodontology (EFP) and the European Association of Dental Public Health (EADPH), with public-health stakeholders and delegates from organized medicine (the World Heart Federation, WONCA Europe and the European Forum for Primary Care), synthesized the epidemiological, mechanistic, preventive and health-systems evidence, and developed consensus recommendations.</p><p><strong>Results: </strong>Oral diseases affect around 3.5 billion people and share modifiable risk factors (free sugars, tobacco, and alcohol) and social and commercial determinants with the major non-communicable diseases (NCDs); inadequate oral hygiene is an additional oral-specific factor. This argues for integrating oral health into general health through a common risk factor approach rather than disease silos. Periodontitis has the strongest evidence for systemic interactions and, unusually among oral diseases, its treatment improves glycemic control in diabetes and inflammatory or vascular surrogates, though evidence for major clinical events remains limited; other links rest largely on shared risk factors and mechanisms (an asymmetry of evidence, not of public-health importance). Prevention and integrated care remain under-implemented.</p><p><strong>Conclusions: </strong>Oral health must be recognized as integral to general health and embedded within NCD strategies and universal health coverage through interprofessional, intersectoral action that also tackles the social and commercial determinants and reduces inequalities.</p><p><strong>Clinical relevance: </strong>Equipping all health and social-care professionals to promote oral self-care, screen and refer, and prioritize periodontal prevention and treatment, can improve both oral and systemic outcomes.</p>","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":" ","pages":""},"PeriodicalIF":17.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic use of extracellular vesicles in dentistry.","authors":"Yu-Chi Cheng, Eren A Keles, David T Wu, David R Walt","doi":"10.1111/prd.70066","DOIUrl":"https://doi.org/10.1111/prd.70066","url":null,"abstract":"<p><strong>Objectives: </strong>To review the diagnostic potential of extracellular vesicles (EVs) in dentistry and evaluate the methodological, translatory, and clinical considerations relevant to their use in oral biofluids.</p><p><strong>Materials and methods: </strong>This narrative review synthesizes current evidence on EVs in dental diagnostics, focusing on saliva, gingival crevicular fluid (GCF), and peri-implant crevicular fluid (PICF). The review examines EV nomenclature, specimen sources, pre-analytical handling, isolation and characterization methods, diagnostic benchmarks, and clinical evidence across major oral diseases.</p><p><strong>Results: </strong>EVs are promising biomarkers because they protect molecular cargo and may enrich disease-relevant signals relative to whole biofluids. Current evidence is strongest for oral squamous cell carcinoma, periodontitis, and peri-implant disease, where EV-associated proteins, RNAs, and microbe-derived signals have shown diagnostic potential. Saliva offers a noninvasive and accessible matrix, whereas GCF and PICF provide greater site specificity for localized disease. However, major barriers remain, including inconsistent nomenclature, co-isolation of non-vesicular particles, variability in sample collection and EV enrichment methods, limited assay standardization, and insufficient multi-site clinical validation.</p><p><strong>Conclusions: </strong>Oral-fluid EVs represent a compelling but early-stage diagnostic platform in dentistry. Their successful translation will require rigorous methodological standardization, MISEV-aligned reporting, robust analytical and clinical validation, and deployment strategies suited to either point-of-care or centralized laboratory testing.</p><p><strong>Clinical relevance: </strong>EV-based assays could support earlier, more objective, and minimally invasive diagnosis and monitoring of oral diseases, particularly periodontal disease, peri-implant disease, and oral cancer, if current technical and translational barriers are overcome.</p>","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":" ","pages":""},"PeriodicalIF":17.8,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolic reprogramming of the immune response in periodontitis.","authors":"Rafael Scaf de Molon, Melissa Grant, Iain Chapple, Joao Paulo Steffens","doi":"10.1111/prd.70073","DOIUrl":"https://doi.org/10.1111/prd.70073","url":null,"abstract":"<p><strong>Objective: </strong>Periodontitis, a highly prevalent chronic inflammatory disease, is characterized by the progressive destruction of the tooth-supporting tissues, ultimately causing tooth loss. In recent years, the emerging field of immunometabolism has revealed that immune cell function is tightly regulated by intracellular metabolic pathways that govern cellular activation, differentiation, and effector responses. Therefore, the aim of this review was to synthesize current evidence on the role of immunometabolism in the pathogenesis of periodontitis, with a particular focus on how metabolic reprogramming regulates innate and adaptive immune responses, contributes to inflammatory bone loss, and represents a potential target for host-modulatory therapies.</p><p><strong>Materials and methods: </strong>A comprehensive narrative review of the contemporary literature was conducted to integrate experimental, translational, and clinical evidence on immunometabolic mechanisms involved in periodontitis. The review examines metabolic regulation of innate and adaptive immune cells, the influence of microbial and systemic metabolic signals on periodontal inflammation, and emerging therapeutic strategies targeting immunometabolic pathways.</p><p><strong>Results: </strong>Current evidence demonstrates that persistent microbial challenge and inflammatory signaling induce profound metabolic reprogramming of immune cells within the periodontal microenvironment. Activated neutrophils, macrophages, dendritic cells, and lymphocytes undergo coordinated shifts in glycolysis, mitochondrial oxidative phosphorylation, fatty acid oxidation, and amino acid metabolism, which regulate immune cell activation, differentiation, and effector functions. These metabolic adaptations promote the production of reactive oxygen species, pro-inflammatory cytokines, and osteoclastogenic mediators, thereby amplifying inflammation and disrupting osteoimmune mechanisms that maintain bone homeostasis. In addition, microbial-derived metabolites further influence host immune metabolism, reinforcing chronic inflammation and periodontal tissue destruction. Emerging preclinical evidence suggests that pharmacological modulation of key immunometabolic pathways may attenuate inflammation and preserve periodontal tissues.</p><p><strong>Conclusion: </strong>Immunometabolic reprogramming is a fundamental mechanism linking microbial dysbiosis to dysregulated host immunity and inflammatory bone loss in periodontitis. A better understanding of the metabolic pathways governing immune cell function may provide important mechanistic insights into disease pathogenesis. By integrating insights from (osteo-)immunology and metabolism, this review proposes immunometabolism as a critical determinant of inflammatory bone loss and a fruitful avenue for the development of novel host-modulatory periodontal therapies aimed at restoring immune homeostasis and preventing periodontal tissue destruction.</p>","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":" ","pages":""},"PeriodicalIF":17.8,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}